Postoperative pneumonia following cardiac surgery in non-ventilated patients versus mechanically ventilated patients: is there any difference?
详细信息 查看全文
- 作者：Nicolas Allou (1) (2)
Jerome Allyn (1) (2)
Aur茅lie Snauwaert (2) (3)
Camille Welsch (2) (3)
Jean Christophe Lucet (4)
Rita Kortbaoui (2) (3)
Mathieu Desmard (2) (3)
Pascal Augustin (2) (3)
Philippe Montravers (2) (3)
1. H么pital Universitaire F茅lix Guyon ; R茅animation Polyvalente ; All茅e des Topazes ; 97400 ; Saint Denis ; France
2. AP-HP ; H么pital Bichat ; D茅partement d鈥橝nesth茅sie-R茅animation ; 46 rue Henri Huchard ; F-75018 ; Paris ; France
3. Univ Paris Diderot ; Sorbonne Paris Cit茅 ; F-75018 ; Paris ; France
4. AP-HP ; H么pital Bichat ; Unit茅 d鈥橦ygi猫ne et de lutte Contre les Infections Hospitali猫res ; 46 rue Henri Huchard ; F-75018 ; Paris ; France - 刊名：Critical Care
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：19
- 期：1
- 全文大小：412 KB
- 参考文献：1. Kollef, MH, Sharpless, L, Vlasnik, J, Pasque, C, Murphy, D, Fraser, VJ (1997) The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 112: pp. 666-75 dx.doi.org/10.1378/chest.112.3.666" target="_blank" title="It opens in new window">CrossRef
2. Hortal, J, Munoz, P, Cuerpo, G, Litvan, H, Rosseel, PM, Bouza, E (2009) Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe. Crit Care 13: pp. R80 dx.doi.org/10.1186/cc7896" target="_blank" title="It opens in new window">CrossRef
3. Hortal, J, Giannella, M, Perez, MJ, Barrio, JM, Desco, M, Bouza, E (2009) Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med 35: pp. 1518-25 dx.doi.org/10.1007/s00134-009-1523-3" target="_blank" title="It opens in new window">CrossRef
4. Leal-Noval, SR, Marquez-Vacaro, JA, Garcia-Curiel, A, Camacho-Larana, P, Rincon-Ferrari, MD, Ordonez-Fernandez, A (2000) Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 28: pp. 935-40 dx.doi.org/10.1097/00003246-200004000-00004" target="_blank" title="It opens in new window">CrossRef
5. Montravers, P, Veber, B, Auboyer, C, Dupont, H, Gauzit, R, Korinek, AM (2002) Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: results of the Eole study. Crit Care Med 30: pp. 368-75 dx.doi.org/10.1097/00003246-200202000-00017" target="_blank" title="It opens in new window">CrossRef
6. Allou, N, Bronchard, R, Guglielminotti, J, Dilly, MP, Provenchere, S, Lucet, JC (2014) Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score*. Crit Care Med 42: pp. 1150-6 dx.doi.org/10.1097/CCM.0000000000000143" target="_blank" title="It opens in new window">CrossRef
7. Device-associated Events Module, Ventilator-Associated Pneumonia (VAP) Event. Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) Report, 2013;6:1鈥?3
8. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388鈥?16.
9. Antibiogram Committee of the French Society for Microbiology. CASFM: http://www.sfm-microbiologie.org/.
10. Bouza, E, Hortal, J, Munoz, P, Pascau, J, Perez, MJ, Hiesmayr, M (2006) Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study (ESGNI-008). J Hosp Infect 64: pp. 224-30 dx.doi.org/10.1016/j.jhin.2006.06.019" target="_blank" title="It opens in new window">CrossRef
11. Allou, N, Kermarrec, N, Muller, C, Thabut, G, Philip, I, Lucet, JC (2010) Risk factors and prognosis of post-operative pneumonia due to Pseudomonas aeruginosa following cardiac surgery. J Antimicrob Chemother 65: pp. 806-7 dx.doi.org/10.1093/jac/dkq030" target="_blank" title="It opens in new window">CrossRef
12. Esperatti, M, Ferrer, M, Theessen, A, Liapikou, A, Valencia, M, Saucedo, LM (2010) Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 182: pp. 1533-9 dx.doi.org/10.1164/rccm.201001-0094OC" target="_blank" title="It opens in new window">CrossRef
13. Kohlenberg, A, Schwab, F, Behnke, M, Geffers, C, Gastmeier, P (2010) Pneumonia associated with invasive and noninvasive ventilation: an analysis of the German nosocomial infection surveillance system database. Intensive Care Med 36: pp. 971-8 dx.doi.org/10.1007/s00134-010-1863-z" target="_blank" title="It opens in new window">CrossRef
14. Rello, J, Ulldemolins, M, Lisboa, T, Koulenti, D, Manez, R, Martin-Loeches, I (2011) Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. Eur Respir J 37: pp. 1332-9 dx.doi.org/10.1183/09031936.00093010" target="_blank" title="It opens in new window">CrossRef
15. Weber, DJ, Rutala, WA, Sickbert-Bennett, EE, Samsa, GP, Brown, V, Niederman, MS (2007) Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia. Infect Control Hosp Epidemiol 28: pp. 825-31 dx.doi.org/10.1086/518460" target="_blank" title="It opens in new window">CrossRef
16. Rello, J, Ausina, V, Ricart, M, Puzo, C, Quintana, E, Net, A (1994) Risk factors for infection by Pseudomonas aeruginosa in patients with ventilator-associated pneumonia. Intensive Care Med 20: pp. 193-8 dx.doi.org/10.1007/BF01704699" target="_blank" title="It opens in new window">CrossRef
17. Trouillet, JL, Chastre, J, Vuagnat, A, Joly-Guillou, ML, Combaux, D, Dombret, MC (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 157: pp. 531-9 dx.doi.org/10.1164/ajrccm.157.2.9705064" target="_blank" title="It opens in new window">CrossRef
18. Verhamme, KM, Coster, W, Roo, L, Beenhouwer, H, Nollet, G, Verbeke, J (2007) Pathogens in early-onset and late-onset intensive care unit-acquired pneumonia. Infect Control Hosp Epidemiol 28: pp. 389-97 dx.doi.org/10.1086/511702" target="_blank" title="It opens in new window">CrossRef
19. Kollef, KE, Schramm, GE, Wills, AR, Reichley, RM, Micek, ST, Kollef, MH (2008) Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria. Chest 134: pp. 281-7 dx.doi.org/10.1378/chest.08-1116" target="_blank" title="It opens in new window">CrossRef
20. Kumar, A, Roberts, D, Wood, KE, Light, B, Parrillo, JE, Sharma, S (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34: pp. 1589-96 dx.doi.org/10.1097/01.CCM.0000217961.75225.E9" target="_blank" title="It opens in new window">CrossRef
21. Fagon, JY, Chastre, J, Hance, AJ, Domart, Y, Trouillet, JL, Gibert, C (1993) Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients. Chest 103: pp. 547-353 dx.doi.org/10.1378/chest.103.2.547" target="_blank" title="It opens in new window">CrossRef
22. Singh, N, Falestiny, MN, Rogers, P, Reed, MJ, Pularski, J, Norris, R (1998) Pulmonary infiltrates in the surgical ICU: prospective assessment of predictors of etiology and mortality. Chest 114: pp. 1129-36 dx.doi.org/10.1378/chest.114.4.1129" target="_blank" title="It opens in new window">CrossRef - 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Introduction No studies have compared ventilator-associated pneumonia (VAP) and non-VAP following cardiac surgery (CS). The aim of this study was to assess the incidence, clinical and microbiologic features, treatment characteristics and prognosis of postoperative pneumonia following CS with a special focus on non-VAP. Methods This was a retrospective cohort study based on a prospectively collected database. We compared cases of non-VAP and VAP following CS observed between January 2005 and December 2012. Statistical analysis consisted of bivariate and multivariate analysis. Results A total of 257 (3.5%) of 7,439 consecutive CS patients developed postoperative pneumonia, including 120 (47%) cases of non-VAP. Patients with VAP had more frequent history of congestive heart failure (31% vs. 17%, P鈥?鈥?.006) and longer duration of cardiopulmonary bypass (105 vs 76 min, P鈥?鈥?.0001), than patients with non-VAP. No significant differences were observed between the 2 groups in terms of the types of microorganisms isolated with high proportions of Enterobacteriaceae (35%), Pseudomonas aeruginosa (20.2%) and Haemophilus spp (20.2%), except for a lower proportion of Methicillin-susceptible S. aureus in the non-VAP group (3.2% vs 7.9%, P鈥?鈥?.03). In the intensive care unit, patients with non-VAP had lower sequential organ failure assessment scores than patients with VAP (8鈥壜扁€? versus 9鈥壜扁€?, P鈥?鈥?.004). On multivariate analysis, in-hospital mortality was similar in both groups (32% in the non-VAP group and 42% in the VAP group, adjusted Odds Ratio (aOR): 1.4; 95% confidence intervals (CI): 0.7-2.5; P鈥?鈥?.34) and appropriate empiric antibiotic therapy was associated with a reduction of in-hospital mortality (aOR: 0.4; 95% CI: 0.2-1; P鈥?鈥?.05). Piperacillin/tazobactam or imipenem monotherapy constituted appropriate empiric therapy in the two groups, with values reaching 93% and 95% with no differences between VAP and non-VAP cases. Conclusions Intensive care patients with VAP are more severely ill than non-VAP patients following CS. Nevertheless, patients with non-VAP and VAP following CS have similar outcomes. This study suggests that the empiric antibiotic regimen in patients with pneumonia following CS should include at least a broad-spectrum antibiotic targeting non-fermenting Gram-negative bacilli, regardless of the type of pneumonia, and targeting S. aureus in VAP patients.